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The Smoking Status Quo: Unacceptable
- The American Anti-Smoking Campaign is
45 Years Old
- According to the CDC:
Tobacco Harm Reduction Brad Rodu Professor, Department of Medicine - - PowerPoint PPT Presentation
Tobacco Harm Reduction Brad Rodu Professor, Department of Medicine - - PowerPoint PPT Presentation
Tobacco Harm Reduction Brad Rodu Professor, Department of Medicine James Graham Brown Cancer Center University of Louisville The Smoking Status Quo: Unacceptable The American Anti-Smoking Campaign is 45 Years Old According to the CDC:
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Lung Cancer (ICD 161-162) Mortality in Men and Women Age 35+, Oklahoma and the US, 1979-2009
50 100 150 200 250
Deaths per 100,000 py
Year OK Men
US Men
OK Women
US Women
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If the Status Quo Continues
In the next 20 years:
- 8 million Americans will die from smoking
All are adults over 35 years of age None of them are now children
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The Failed Anti-Smoking Campaign
- The Campaign’s Only Message:
Quit Nicotine and Tobacco, or Die
- The Campaign’s Only Quitting Tactics:
Ineffective Behavioral Therapy Ineffective Use of Nicotine
Rodu and Cole. Technology 6: 17-21, 1999. Rodu and Cole. International J Cancer 97: 804-806, 2002.
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The Anti-Smoking Campaign- Behavioral Therapy
- NCI Manual for Physicians- Counsel
Patients to:
– ”Keep your hands busy- doodle, knit, type a letter” – ”Cut a drinking straw into cigarette-sized pieces and inhale air” – ”Keep a daydream ready to go”
Source: How to help your patients stop smoking. NIH Pub. No. 93-3064, 1993
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The Anti-Smoking Campaign- Faulted Use of Nicotine
- Temporary – 6 to 12 weeks
- Expensive – per unit and per box
- Very Low Dose – unsatisfying for smokers
- 7% Success* – ”Efficacious”, ”Modest”
*Hughes et al. Meta-analysis in Tobacco Control, 2003.
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Comparing Nicotine to Caffeine Addictive Drugs Can Be Used Safely
Properties of Nicotine and Caffeine
Pleasurable Effects: Enhance concentration and performance Provide a sense of well being Elevate mood Powerfully Addictive: Irreversible for many consumers Can be Used Safely: Do not cause Cancer, Emphysema, Heart Diseases Delivery Systems: Caffeine- Coffee, tea, cola drinks Nicotine- Smoke versus smokeless
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Tobacco Harm Reduction Permanent Nicotine Maintenance
Smokeless Tobacco
- Nicotine levels comparable to smoking
- Vastly safer than smoking (>98%)
- Evidence from Sweden – and the U.S. – that
smokeless works
- Modern products are socially acceptable
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American Smokeless Tobacco
Moist Snuff Chewing Tobacco Powdered Dry Snuff
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Smokeless Tobacco Use is 98% Safer Than Smoking
- No risk for emphysema, lung cancer,
and heart disease
- Mouth cancer risk - Very low in
absolute terms*
* 22 studies over 50 years: Rodu and Cole, Oral Surgery 2002.
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Smokeless Tobacco and Health: Oral Cancer
Relative Risks Smoking ~10 Alcohol Abuse ~4 American Smokeless Tobacco* Chewing tobacco 1.2 Moist snuff 1.0 Powdered Dry Snuff 4.0 Incidence Rate in Long-term ST users (At RR=4): 26 per 100,000 person-years (py)**
* Over 20 epidemiologic studies, reviewed in: B Rodu, P Cole. Oral Surgery 93: 511-515, 2002. **New England Journal of Medicine 304: 745-749, 1981.
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Comparing Risks of Smokeless Tobacco, Automobiles and Cigarettes
Annual Death Rate from: Powdered dry snuff1 12 per 100,000 users Automobiles2 11 per 100,000 users Cigarettes3 > 600 per 100,000 users
- 1. New England Journal of Medicine, 1981.
- 2. National Highway Traffic Safety Administration, 2009.
- 3. American Cancer Society data, 1999.
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Smokeless Tobacco Has Worked For Swedish Men For 50 Years
- High rate of smokeless tobacco use.
- Lowest smoking rate in Europe.
- Lowest rate of lung cancer and other smoking-
related diseases in Europe
- If EU men smoked at the rate of Swedish men,
almost 274,000 lives per year would be saved*
*B Rodu and P Cole. Scandinavian Journal of Public Health, 2009.
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Tobacco Use in Northern Sweden
From J Int Med 2002; Scand J Pub Health 2005
5 10 15 20 25 30 35 40 45 1986 1990 1994 1999 2004 1986 1990 1994 1999 2004 Percent Year
Men Women
Snus
Smoking
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Growing Discussion about Tobacco Harm Reduction
2002 Royal College of Physicians Report ”...[smokeless] tobacco...10 to 1,000 times less hazardous than smoking...some manufacturers want to market ST as a harm reduction option...may find support for that in the public health community” 2007 Royal College of Physicians Report Smokers smoke predominantly for nicotine,…nicotine itself is not especially hazardous. Harm reduction
- a fundamental component of many aspects of medicine
and…everyday life…has not been applied to smoking.
- has the potential to save millions of lives, and deserves
consideration.
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Growing Discussion about Tobacco Harm Reduction
2006 Addictive Behaviors, NCI Funded “…4 million [American] smokers would switch to the low- carcinogen smokeless tobacco.” American Council on Science and Health Harm Reduction Journal, 2006 and 2011 ”....there is a strong scientific and medical foundation for tobacco harm reduction, which shows great potential as a public health strategy to help millions of smokers.”
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Tobacco Harm Reduction The Owensboro, KY Campaign
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E-cigarettes
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Tobacco Harm Reduction: Take-Homes
- Eliminate misinformation on state government tobacco web
pages such as:
“smokeless tobacco doesn’t mean harmless tobacco…One can of chew equals about four packs of cigarettes…an almost instant addiction… Smokeless tobacco is not a safe replacement for smoking cigarettes”
- Don’t ”equalize” taxes on smokeless tobacco with those on
cigarettes: it denies smokers affordable options
- State employee smokers who switch save essentially as many
health care dollars as smokers who quit
- Set insurance rates that don’t penalize smokers who switch
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